Day 2 -- Ethics and Horses

If you attend AAEP conventions there is a phrase heard over and over, year after year. It burrows into the brain with the persistence of a nursery rhyme, mantra, or Elton John lyric. "The Health and Welfare of the Horse." Whether it's stated outright or just implied, every session and every event comes back to that phrase. It makes sense, since for equine practitioners, that's really what it's all about.

The sessions I attended yesterday afternoon were less medical and more philosophical. The closest anything came to clinical medicine was the discussion of diagnostic techniques used to detect soring in gaited show horses.

Instead of diagnosing and treating diseases, with both sessions the prevailing theme was the impact of human choices on the health and welfare of the horse.

I wonder sometimes if people realize how much time veterinarians spend in ethical wrangling--with each other and with ourselves. Sometimes I'm not even sure that we realize it. But, the tricky part of veterinary medicine, particularly equine practice where our patients actually earn paychecks, is that our patients do not pay their own medical bills. Veterinarians face a conflict of interest every time we roll out of bed for a work day.

But, of course, we don't deal with this ethical quandary in a vacuum. The first speaker in the session on "Ethics, Scope of Practice, and Racing" was Dr. Stephen Galloway talking about the regulation of veterinary medicine. Veterinarians are licensed professionals, like physicians, nurses, lawyers, and accountants. As such, we are licensed and regulated by bodies known as Boards of Veterinary Examiners (BVE). These boards regulate at the state level; there is no national regulation of veterinarians. What a lot of folks don't realize is that the BVEs exist to protect the consumer, not the profession.

The BVEs regulate the legalities of the veterinary profession. A key point made by Dr. Galloway was that legal practice defines what veterinarians can do. Ethical practice defines what veterinarians should do. He gave a trenchant example of the distinction. It may be legal (under certain circumstances) for a veterinarian to dispense sedation or to sedate a horse for a lay dentist. However, supporting medical practice by nonlicensed, non-medically trained practitioners is hardly ethical.

Yes, I know that isn't a popular point, but I happen to agree. When health care procedures are performed by individuals without medical backgrounds who have no oversight (go back to the consumer protection thing) and no, or little, medical training, the horse (and ultimately the consumer) loses.

Dr. Rick Lesser spoke on some of the more esoteric aspects of ethics and morality, but the bottom line was this: "Complex moral issues don't lend themselves to simple, clear-cut answers." From here, he made the point that the very complexity of ethics forces the examination and discussions that we need to have in order to move beyond our own biases, fears, and desires. The ethical struggle ultimately leads to moral action. "There has to be a struggle. There has to be tension. And we have to get involved in it."

Tensions in the horse world often run highest around racing and performance issues. Dr. Scott Palmer and Dr. Jeff Blea each addressed the ethical dilemmas faced in racetrack practice. Track vets have the complexity deck stacked against them. The veterinary-client-patient relationship morphs into the veterinary-owner-trainer-horse relationship, adding another level of complication. And, as Dr. Palmer said, the public perceives medications in racing as damaging, veterinarians are the purveyors of medication, ergo, the PR bullseye lands squarely on the veterinary back.

So, now what? Do equine vets roll over? Give up in the face of complex issues? Stick with what is legal and let the ethics sort themselves out? Nope.

Dr. Blea pointed out that the business model of racetrack medicine needs to change, shifting the income from goods (i.e., medications) to services since medications and medical rules still drive most of the ethical dilemmas in racetrack practice.

Dr. Palmer summed it up best: "We need to be the advocates for the horse." Good advice for all of us, from backyard to racetrack.